Privacy and Confidentiality

This notice describes how medical information about you may be used and disclosed. It also describes how you can get access to this information. Please review it carefully.

In order to provide you care, Elisha Geers (your “Provider”) must collect, create and maintain health information about you, which includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. Your Provider is required by law to maintain the privacy of this information. This Notice of Privacy Practices (this “Notice”) describes how your health information may be used and disclosed, and explains certain rights you have regarding this information. Your Provider is required by law to provide you with this Notice, and will comply with the terms as stated.

Washington Medical Records Notice

Your Provider will keep a record of the health care services that are provided to you.  You may ask your Provider to see and copy that record.  You may also ask your Provider to correct that record.  Your Provider will not disclose your record to others unless you direct your Provider to do so or unless the law authorizes or compels your Provider provider to do so.  You may see your record or get more information about it by contacting your Provider via email.

How Provider Uses and Discloses Your Health Information

Your Provider protects your health information from inappropriate use and disclosure, and will use and disclose your health information for only the purposes listed below:

1. Uses and Disclosures for Treatment, Payment and Health Care Operations. Your Provider may use and disclose your protected health information in order to provide your care or treatment, obtain payment for services provided to you and in order to conduct our health care operations as detailed below.

1. Treatment and Care Management. We may use and disclose health information about you to facilitate treatment, and coordinate and manage your care with other health care providers.

2. Payment. We may use and disclose health information about you for our own payment purposes and to assist in the payment activities of other health care providers. Our payment activities include, without limitation, determining your eligibility for benefits and obtaining payment from insurers that may be responsible for providing coverage to you, including Federal and State entities.

3. Health Care Operations. We may use and disclose health information about you to support health care functions related to treatment and payment, which include, without limitation, care management, quality improvement activities, evaluating our own performance and resolving any complaints or grievances you may have. We may also use and disclose your health information to assist other health care providers in performing health care operations.

1. Exceptions to Confidentiality. Your participation in clinical services, the content of our sessions, and any information I maintain about you is protected by legal confidentiality.  Some exceptions to confidentiality are the following situations in which I may choose to, or be required to, disclose this information:

•  If you give me written consent to have the information released to another party;

•  In the case of your death or disability I may disclose information to your personal representative;

•  If you waive confidentiality by bringing legal action against me;

•  In response to a valid subpoena from a court or from the secretary of the Washington State Department of Health for records related to a complaint, report, or investigation;

•  If I reasonably believe that disclosure of confidential information will avoid or minimize an imminent danger to your health or safety or the health or safety of any other person;

•  To county coroners and medical examiners for the investigations of deaths;

•  To coordinate referrals and care with other current or former providers or facilities that I reasonably believe are providing, or have provided, healthcare to you;

•  To coordinate payment with third party payors for the services I provide to you;

•  To law enforcement when I believe in good faith that the information is evidence of criminal conduct that occurred on my premises.

As a mandated reporter, I am required by law to disclose certain confidential information including suspected abuse or neglect of children under RCW 26.44, suspected abuse or neglect of vulnerable adults under RCW 74.34, or as otherwise required in proceedings under RCW 71.05. The full rule of confidentiality for healthcare providers in Washington can be found in RCW 70.02.

1. Special Treatment of Certain Records. HIV related information, genetic information, alcohol and/or substance abuse records, mental health records related to services provided by a New York Article 31 mental health clinic and other specially protected health information may enjoy certain special confidentiality protections (that are more restrictive than those outlined above) under applicable state and federal law. Any disclosures of these types of records will be subject to these special protections.

2. Obtaining Your Authorization for Other Uses and Disclosures. Certain uses and disclosures of your health information will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing purposes; and (c) that constitute a sale of health information under the Privacy Rule. Your Provider will not use or disclose your health information for any purpose not specified in this Notice unless we obtain your express written authorization or the authorization of your legally appointed representative. If you give us your authorization, you may revoke it at any time, in which case we will no longer use or disclose your health information for the purpose you authorized, except to the extent we have relied on your authorization to provide your care.

Your Rights Regarding Your Health Information

You have the following rights regarding your health information:

1. Right to Inspect or Get a Copy of Your Medical Record. You have the right to inspect or request a copy of health information about you that we maintain. Your request should describe the information you want to review and the format in which you wish to review it. We may refuse to allow you to inspect or obtain copies of this information in certain limited cases. We may charge you a fee of up to $.75 per page for copies or the rate established by the Department of Health. We may also deny a request for access to health information under certain circumstances if there is a potential for harm to yourself or others. If we deny a request for access for this purpose, you have the right to have our denial reviewed in accordance with the requirements of applicable law.

2. Right to Request Changes to Your Medical Record. You have the right to request changes to any health information we maintain about you if you state a reason why this information is incorrect or incomplete. Your Provider might not agree to make the changes you request. If we do not agree with the requested changes we will notify you in writing and inform you how to have your objection included in our records.

3. Right to an Accounting of Disclosures. You have the right to receive a list of all disclosures we have made of your health information. The list will not include disclosures made for certain purposes including, without limitation, disclosures for treatment, payment or health care operations or disclosures you authorized in writing. Your request should specify the time period covered by your request, which cannot exceed six years. The first time you request a list of disclosures in any 12-month period, it will be provided at no cost. If you request additional lists within the 12-month period, we may charge you a nominal fee.

4. Right to Request Restrictions. You have the right to request restrictions on the ways which we use and disclose your health information for treatment, payment and health care operations, or disclose this information to disaster relief organizations or individuals who are involved in your care. We are required to comply with your request if it relates to a disclosure to your health plan regarding health care items or services for which you have paid the bill in full, though in other instances, we may not agree to the restrictions you request.

5. Right to Request Confidential Communications. You have the right to ask us to send health information to you in a different way or at a different location. Your request for an alternate form of communication should also specify where and/or how we should contact you.

6. Right to Receive Notification of Breach. You have the right to receive a notification, in the event that there is a breach of your unsecured health information, which requires notification under the Privacy Rule.

7. Right to Paper Copy of Notice. You have the right to receive a paper copy of this Notice of Privacy Practices at any time.

To make a request as described in any of the above, please contact your Provider.

Right to File Complaints

If you believe your privacy rights have been violated you may file a complaint with your Provider or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against by your Provider for filing a complaint.

Your Provider acts as their own privacy officer and security officer and can be contacted at elisha.geers@ikoicounseling.com or 206-385-8727

Changes to this Notice

Your Provider may change the terms of this Notice of Privacy Practices at any time. If the terms of the Notice are changed, the new terms will apply to all of your health information, whether created or received by your Provider before or after the date on which the Notice is changed. Any updates to the Notice will be provided to you.